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Anthem Insurance Plans Q&A

Mary Washington Healthcare’s (MWHC) Anthem Blue Cross contracts are scheduled to terminate on February 28, 2023. We continue to negotiate with Anthem in good faith, but regardless of the outcome, we are here to take care of all who seek care. As the only health system in the region with advanced services such as comprehensive cancer services, neurosurgery, open heart surgery, and Level III NICU staffed by top-ranked Children’s National neonatologists, MWHC serves a critical role in caring for those in need of highly specialized medical care. MWHC has a long-standing tradition of caring for our community; asking for fair and equitable payment from entities like Anthem ensures we remain strong to carry forward this tradition for generations to come.

As we continue to negotiate with Anthem, you may have questions about what this means for you and your family. If we don’t have a new Anthem contract in place by February 28, 2023, all MWHC physicians and facilities will be out of Anthem’s network. However, we will still care for people with Anthem insurance and will work with each patient on payment options for their increased out of network expenses. By law, Anthem is required to continue to cover services after February 28 for patients who have scheduled procedures, are already admitted to MWHC hospitals, or who are in ongoing treatment, like expectant mothers or patients receiving cancer treatments. In addition, Anthem is required to cover emergency services as in-network.

Please continue reading for additional information on what you can expect during this time.

Q: Which specific Anthem products will be out of the Mary Washington network if a new agreement isn’t reached by March 1?

A: Affected Anthem plans include:

HealthKeepers HMO, Traditional PPO, Indemnity PPO, Healthkeepers Plus Medicaid, Federal Employee PPO, Medicare Advantage plans, insurance exchange plans, and any BCBS PPO plan that accesses the Blue Card Network (excluding Carefirst BCBS plans).

Plans not affected may include Medicare supplement plans, which typically cover co-insurance, deductibles, and sometimes other items not covered by Medicare. If you have a Medicare supplement plan and want to confirm your coverage, we recommend calling the number on the back of your Anthem insurance card.


Q: What specific MWHC services would be out of Anthem’s network if a new agreement isn’t reached by March 1?

A: All contracted MWHC facilities, physicians and services would be out of network including: Mary Washington Hospital, Stafford Hospital, Snowden at Fredericksburg, Fredericksburg Ambulatory Surgery Center, Fredericksburg Endoscopy Center, Mary Washington Urgent Care, Mary Washington Physical Therapy, all Mary Washington Medical Group offices, Mary Washington Eye Care Center, and all Mary Washington outpatient departments.

The only Mary Washington affiliated services which would remain in network would be Mary Washington Home Health, Mary Washington Hospice and all Medical Imaging of Fredericksburg locations. These entities have separate Anthem contracts.


Q: Does this mean Anthem patients can’t go to Mary Washington and Stafford for care?

A: No. We are continuing to negotiate with Anthem in good faith, but regardless of the outcome, we are here to take care of all who seek care with us. We’ve always cared for everyone regardless of insurance or ability to pay, and we’ll continue to do just that. If we don’t have a new Anthem contract in place before March 1, 2023, MWHC facilities (Mary Washington Hospital, Stafford Hospital, Snowden at Fredericksburg, Fredericksburg Ambulatory Surgery Center, and Fredericksburg Endoscopy Center) and all Mary Washington Medical Group physicians will be out of Anthem’s network. However, we’ll still care for people with Anthem insurance, and will work with each patient on payment options for their increased out of network expenses.


Q: Will Anthem patients have to pay higher out of pocket costs at MWHC?

A: It depends on your specific Anthem plan. Regardless of your plan, we’re committed to provide care to you and we will work with you on payment options customized to your needs.


Q: Isn’t this all just about money?

A: This is about fairness. Anthem is paying the healthcare facilities and doctors in our region 24 percent less than their average payment rates. We are only asking Anthem to pay facilities and physicians in the Fredericksburg region fairly for the care provided.

Anthem payment rates


Q: Why am I just now being notified of this issue? I enrolled in my insurance plan a couple months ago and I would have made a different choice had I known about this dispute.

A: Anthem knows who their customers are whereas MWHC does not have a way to identify all the Anthem members in our community. It is Anthem’s responsibility to notify its members of a potential network problem. We agree that it is unfortunate that Anthem only notified you of this issue now.


Q: Won’t MWHC lose patients to other hospitals if they don’t have Anthem contracts?

A: We hope not, but realize some people may choose other facilities. We’re committed to working with patients to develop payment plans they can afford, regardless of their insurance coverage.


Q: Some important services such as advanced cancer services or brain and heart surgery aren’t available anywhere else in the community. What will happen if Anthem patients need these services?

A: We’re committed to providing excellent care regardless of your insurance coverage or ability to pay. If you have an advanced medical need, we’ll care for you and work out payment options with you.


Q: What if I have Anthem coverage and I have an emergency? Can I still go to a Mary Washington Healthcare Emergency Department?

A: Yes. Emergent services are covered as “in-network.”


Q: Anthem is saying that MWHC voluntarily terminated its contracts. Is this true?

A: Terminating the contracts was the only way Anthem would discuss contract changes. Again, we just want to be paid fairly, and unfortunately, the way an Anthem contract works, we are forced to terminate the contract to attempt to negotiate a new, fair deal.


Q: When will you know if you will have new contracts in place?

A: We are communicating with Anthem often and hope to have new contracts in place before the old ones expire. We’ll continue to update our website with the latest.


Q: I am in active treatment for an ongoing medical need at a Mary Washington facility (or by a Mary Washington doctor). Does this mean I have to change my doctors or be forced to pay Anthem’s higher out of network rates?

A: By law, Anthem is required to continue to cover services after February 28 for patients who have non-elective procedures scheduled, are admitted to Mary Washington or Stafford Hospitals, or who are in ongoing treatment. So, Anthem’s contract status with MWHC is irrelevant in these cases. Call our Patient Financial Navigators at 540.741.1041 and we can help you understand Anthem’s responsibility. We encourage you to complete an Anthem Continuity of Care Request Form if any of the circumstances listed below apply:

  • You are in treatment for a serious and complex condition. (This can be a sudden illness that requires specialized treatment in order to avoid death or permanent harm. It can also be an ongoing illness that is life threatening or potentially disabling and requires specialized care over a long period of time.)
  • You are in a hospital or other inpatient facility.
  • You are scheduled for non-elective surgery by your current doctor, including your post-operative care for the surgery.
  • You are pregnant.
  • You are terminally ill.

Q. Is there anything patients or the community can do to make their voices heard about this issue?

A. Your support makes a difference as we work toward an agreement with Anthem. You can help us by calling Anthem and asking them to pay MWHC fairly. Remember, Anthem pays your local healthcare providers 24 percent less than they pay healthcare providers across Virginia. If Anthem would just pay fairly, there would be no dispute. It’s also not fair that Anthem sold you or your employer an insurance plan in the Fredericksburg region without having many of the region’s doctors and healthcare facilities participating in that plan. Anthem can be reached at 800.331.1476 or by dialing the number on the back of your Anthem insurance card. In addition to calling, Anthem members can also log in to their Anthem portal and choose the “send a message” function. Please use any of the information we have provided above in your message to Anthem.